More than 50 years after Ken Kesey’s novel, One Flew Over the Cuckoo’s Next, state psychiatric hospitals of the sort he described are, like lobotomies, long gone. Yet if we think that the hellish world Kesey captured belongs to another era, we are deluded.

It’s true that the hospitals have mostly disappeared: between 1950 and 2000 the number of people with serious mental illness living in psychiatric institutions dropped from almost half a million people to about 50,000. But none of the rest of it has gone away, not the cruelty, the filth, the bad food or the brutality. Nor, most importantly, has the large population of people with mental illness, who are kept largely out of sight, their poor treatment invisible to most ordinary Americans.

The only real difference between Kesey’s time and our own is that the mistreatment of people with mental illness now happens in jails and prisons. Today, the country’s largest providers of psychiatric care are not hospitals at all, but rather the jails in Chicago, Los Angeles and New York City.

That there are so many people with mental illness locked in our jails and prisons is but one piece of the crisis. Along with race and poverty, mental illness has become a salient feature of mass incarceration, one that must be accounted for in any discussion about criminal justice reform.